Pharm

Question 1

aminosteroid derivatives of NMBs

Answer 1

Rocuronium
Vercuronium
Non-depolarizing.
Organ dependent (do not use with organ failure).
Can use Suggumadex for reversal.

Question 2

benzylisoquine derivatives of NMBs

Answer 2

Atracurium
Cistracurium
Non-depolarizing.
Organ independent (safe for use with organ failure).
Can NOT use suggumadex for reversal (use AChE only)

Question 3

succinylcholine

Answer 3

Depolarizing NMB.
Organ independent (safe for organ failure).
Bad side effects.
No reversal agents.

Question 4

Drugs that potentiate NMB blockade

Answer 4

Antibiotics
Inhaled anesthetics
Calcium channel blockers
Local anesthetics

Question 5

gold standard for TOF ratio for post-op recovery

Answer 5

TOF ratio > 0.9

Question 6

NMB reversal (& side effects of reversal agents)

Answer 6

(1) AChE inhibitor
Side effects: muscarinic - bradycardia, increased intestinal tone) –> given with antimuscarinic agent to cancel

(2) Sugammadex
Side fx: minimal, maybe with oral contraceptives. ONLY used for R/V

Question 7

Propofol mechanism

Answer 7

Enhances GABA inhibition.

Inhibits synaptic transmission

Question 8

Dexmedetomidine mechanism

Answer 8

Inhibits NE release.
Only GABA is stimulated.
Inhibits synaptic transmission.

Question 9

Ketamine mechanism

Answer 9

Inhibits GABA pathway.

Increases neural activity, but disordered. Cannot communicate.

Question 10

lambda (solubility)

Answer 10

Low lambda = quick onset bc prefers air

drug in blood/drug in lungs

Question 11

volatiles side effects

Answer 11

Mainly cardiovascular.
Decreased CO, MAP, RR.
Bronchodilation.

Question 12

nitrous oxide side effects

Answer 12

None.
Accumulates in closed spaces.
Contraindicated if pneumothorax.

Question 13

propofol side effects

Answer 13

Decreased CO, MAP, RR.

Hypertriglyceridemia.

Question 14

ketamine side effects

Answer 14

INCREASED CO, HR, MAP, RR.
Hallucinations.
Secretions.

Question 15

etomidate side effects

Answer 15

None.

Adrenal suppression –> clin sig mortality rate

Question 16

dexmedetomidine side effects

Answer 16

Decreased CO, HR, MAP, RR.

Question 17

esters

Answer 17

Local anesthetic.
Safer.
One "i"
Metabolized by plasma/pseudocholinesterase.
Degraded to PABA.

Question 18

amides

Answer 18

Local anesthetic.
Less safe.
Metabolized by liver CYP450.
Longer half life.

Question 19

local anesthetics interactions

Answer 19

Heart disease: increases toxicity.
Renal disease: no effect.
Hepatic disease: severe effects.
Decreased AChE activity: increases toxicity
Sepsis, malignancy, ischemia: increases protein binding, increases onset time

Question 20

systemic toxicity of LAs

Answer 20

1) CNS
2) Respiratory
3) Cardiovascular